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Sunday, May 2, 2010

Meningitis in a dog

Meningitis is a life-threatening disease involving inflammation of the layers that protect the brain and spinal cord. I treated my first case of meningitis in a nine-month-old chocolate labrador retriever that was presented to me a few days ago (day one) for inappetence and lethargy, that's it. Being a labrador with a history of having eaten six rawhides in the few days preceding the visit, I treated her symptomatically for stomach upset. The following day (day two), her symptoms were much more specific. She had a stiffed gait and would not dare budge her neck or allow me to manipulate her head. Her temperature was normal.
I got on the phone with a nearby board-certified veterinary neurologist and said to her, "I'm pretty sure I have a dog with either meningitis or an acute disc prolapse."
"She probably too young for a disc," she told me, "she has meningitis." After discussing with the owner the likely diagnosis and quote for a referral for a CSF-tap (an important analysis of the fluid surrounding the brain and spinal cord), the owner elected to have me treat the dog and declined the referral due to its high cost. The neurologist gave specific doses for steroids (dexamethasone) and antibiotics should the owner not be able to make the referral.
The dog responded within four hours of treatment, and walked out of the clinic with much more ease than when she was presented to me. She continues to improve.
The dog likely has steroid-responsive meningitis, or auto-immune meningitis, where the body produces antibodies against its own tissues and this produces a massive inflammatory response. It is unknown why this occurs. Antibiotics were used in this case because a CSF-tap was not performed, making bacterial meningitis a possibility as well.
Meningitis can occur because of viruses, bacteria, fungi, and parasites, as well as different types of steroid-responsive meningitides (the plural of meningitis), as discussed above. Pugs get their own type of meningitis, called granulomatous meningo-encephalitis (or GME), for which steroids are used in its treatment. There are other breed-specific types of the disease.

Interesting case, but I'd rather treat an ear infection than meningitis given the much better prognosis with the former.


Collecting cerebrospinal fluid from a dog requires practice and technical skill.

15 comments:

Robyn said...

I enjoy the stories where the history sends you on the wrong track... at least the ones with happy endings. It really shows how important detective work is in diagnosis and how a good diagnostician keeps an open mind.

Anonymous said...

Your blog is an inspiration to me :)
Lilliana

TorontoVet said...

Lilliana,

Your comment is an inspiration to me.

cgesin said...

I just read your blog...my chocolate lab was diagnosed with steroid responsive meningitis at 9 months old also. She had a very high fever, but no symptoms. The vet diagnosed her with fever of unknown origin (it went up to 106.1). Then after being hospitalized for two days she came home where she developed symptoms that you described. She couldn't move her neck and she was really weak and couldn't even go up the stairs or sit down. We took her to the ER at University of Penn and they thought she had meningitis. We did opt for the testing and she was given a spinal tap, which showed that she had meningitis. Now she has to take steroids for 6 months! Have you seen many cases meningitis? A question to you...any suggestions on the peeing? The steroids are making her pee herself and pee all over my house. We let her out at least once an hour but she still seems to pee in the house. I don't know if I can take six months of this!!! Help me! My husband and I love our dog Hershey to death and would do anything to help her!!

LyndaSchewe said...

Can a dog get auto Immune meningetis from a bad reaction to a 3year Rabie shot? My 5 year old French Bulldog had a 3 year Rabies in August, and began to slow down, not want to go for walks, could not jump on sofa, by December he had glazed look, shaking head, licking paws, back end collapse...he went into emergency for MRI and we ruled out tumors, had spinal tap and found auto immune...he is now on steroids, and antibiotics with Pheno barbital for 30 days. will he recover? will he have to stay on steroids???

TorontoVet said...

It's possible, but impossible to prove. Many dogs develop auto-immune disease without having been vaccinated so no studies showing any correlation. I hope he recovers fully.

Carrie Patten said...

My dog is 2 1/2 years old and the symptoms started for her a few months after she turned 1. They were thinking possibly auto-immune since the tick tests were negative. But they want to rule out everything before trying steroids. She was tested for toxoplasmosis, lupus, valley fever, cushings, and giardia and all were negative, they tested her twice now for everything thinking maybe they were wrong the first time. She runs a fever and gets really lethargic and just lays and stares glassy eye, it is very scary. She will also stop eating and acts like her legs and back are sore because she stops jumping on the bed or couch and walks differently. Once the antibiotics start she gets better. They tested her for Cushings because her white blood cells were elevated they are at 27,000 and also her potassium is low, liver is high, and cholesterol is high, but she is negative for Cushings. She has no anemia either. Most of the time she takes the antiobiotis for a few weeks and then about a week later she is sick again. The longest she has went without getting sick is 5 Months when she was on doxy for 3 weeks so we are trying doxy again now for 3 Months which she just finished. Also they did the ANA test and say because that was negative she does not have an autoimmune disease. I am praying she does not get sick again but wanted to know if anyone has any indication on what this can be we have seen so many Dr's and the spent over $2000 and don't know how much more we can spend

Carrie Patten said...

My dog is 2 1/2 years old and the symptoms started for her a few months after she turned 1. They were thinking possibly auto-immune since the tick tests were negative. But they want to rule out everything before trying steroids. She was tested for toxoplasmosis, lupus, valley fever, cushings, and giardia and all were negative, they tested her twice now for everything thinking maybe they were wrong the first time. She runs a fever and gets really lethargic and just lays and stares glassy eye, it is very scary. She will also stop eating and acts like her legs and back are sore because she stops jumping on the bed or couch and walks differently. Once the antibiotics start she gets better. They tested her for Cushings because her white blood cells were elevated they are at 27,000 and also her potassium is low, liver is high, and cholesterol is high, but she is negative for Cushings. She has no anemia either. Most of the time she takes the antiobiotis for a few weeks and then about a week later she is sick again. The longest she has went without getting sick is 5 Months when she was on doxy for 3 weeks so we are trying doxy again now for 3 Months which she just finished. Also they did the ANA test and say because that was negative she does not have an autoimmune disease. I am praying she does not get sick again but wanted to know if anyone has any indication on what this can be we have seen so many Dr's and the spent over $2000 and don't know how much more we can spend

Paige Sted said...

great post..i enjoy reading it. The symptoms that indicate meningitis can mimic those of other medical conditions. That is why it is important to show your dog to a vet so that potential problems can be ruled out.

Campbelltown Vet

Anonymous said...

My Sadie had her spinal tap yesterday...has autoimmune meningitis...the doctor has her on all of this: high steriods, gabapentin, tramadol, cyclosporine and xanex....i dont know how i am going to monitor her progress because it just makes her eat and drink alot and then just sleep...i was told what to look for if she is declining but couldnt that happen and I not notice because she is so zonked out? This is the hardest thing i have ever watched...she means the world to me

Casey said...

My 2.5 year old mini schnauzer was diagnosed with SMRA after a MRI and csf test. He was unable to walk going to the emergency teaching hospital (had ataxia). He was VERY SLOW to respond to treatment, which does not seem like the norm in the blogs that I have read. He had his first big dose (aggressive treatment) on a Wednesday, and was WORSE on Thursday, but then on Friday and Saturday he made such incredible progress that I was able to bring him home Saturday afternoon. He is still not right as rain, and that is another reason I am writing this. He is lethargic, wants to eat, sleep, and drink water. BUT, very slowly some of the pre-trauma pup is coming out. He was very excited to see a friend of mine, asked to sit in my lap after breakfast, knows to run outside to go to the bathroom, etc. He still is not into major cuddling, which is not like him, but I am hoping that improves. He still has a wicked head bobble, as the inflammation reached his caudate nucleus as well as his cerebellum. My vet did not tell me some things about his homecoming. Now, I realize I should have asked - is my dog in pain still? He seems so uncomfortable most of the time. Does anyone know of some helpful literature on pups recovering from SMRA? Any helps for nervous moms?

Rachelle said...

Awesome!

Anonymous said...

This story does not have a happy ending. Three days ago, Max, my 5 year old long-haired Chihuahua seemed to have a back injury. He was somewhat hunched over and I brought him to the vet who suggested chiropractic treatment, which was done on L5 & L6. I took Max home and got him settled down for the night. The next morning he did not want to walk and so I brought him back to the vet who said it was probably a disc problem and to keep him quiet for at least 7 days. I took him home and within an hour he had a seizure. I immediately brought him back to the vet and there were two of them puzzling over the situation from 10:00 a.m. to 3:30 pm when at last Max died when his respiratory system failed. At 2:00 pm one vet suggested meningitis but the other was not so sure so no prednisone was given but homeopathic remedies were tried (I did not know what was happening, to tell the truth). Then around 2:30 one of the vets tried to give Max oral prednisone and because he was having difficulty swallowing he went into a massive seizure resulting in his having to be intubated because he lost the ability to breathe on his own. The vet said his heart, however, was fine but he remained absolutely unresponsive otherwise. Finally, at 3:30, I agreed to let him go. I only wish the vets had acted sooner regarding the thought of meningitis because it was too late to move him by the time he need help breathing. So sad.

Anonymous said...

I had a giant schnauzer, only 6 months old, no symptoms of any sort. Took her for spaying, and when I took her home from spaying, she spiraled out of control. Day 1 she slept most of the time, and attributed it to her surgery, but that night I realized she was acting blind. Next day before the vet was even open for me to check the blindness, she started having seizures. Blood work was done, they suggested something neurological was going on, but no one really knew what happened. They tried treating the seizures. within 12 hours we ended up at an ER vet and had to put her down, her temperature had spiked so high it was unreadable, and they couldn't stop the seizing (she was in a seizure for over an hour). They did a necropsy and it's been a few weeks, but today they told me it was meningitis with encephalitis (sp). I've never heard of meningitis in dogs until now, and now I am trying to read more about it. I am so saddened that she had no symptoms at all pre-operation. They think her body was fighting it and the surgery compromised her immune system, allowing the meningitis to take over. Horrible thing to watch happen.

Cliff Mardinger said...

I am so sorry this has befallen your beloved pet. Do you know if this was either bacterial or sterile meningitis? Take care.